In December 2016, President Obama signed the 21st Century Cures Act, which included $1 billion in new funding to fight the opioid epidemic.
The Cures Act allocation is the latest government effort to address the country's pressing issue of opioid misuse, which, according to the CDC, killed more than 41 people a day in 2015. The Agency for Healthcare Quality and Research (AHQR) recently reported that opioid-related death rates have increased by 200 percent between the years 2000 and 2014.
The financial impact of opioid abuse is also substantial, with opioid poisonings accounting for over $20 billion a year in emergency department and hospital care, per the AHQR. The Cures Act aims to reverse this trend by expanding community-based prevention efforts and access to treatment, providing support to individuals in recovery and increasing drug enforcement efforts.
Individual states are also implementing measures to address rising rates of prescription drug abuse. Most states now track controlled substance prescribing through state prescription drug monitoring programs, while Minnesota, New York and Maine have legislation requiring the use of e-prescribing for both legend drugs and controlled substances. New York's Internet System for Tracking Over-Prescribing (I-STOP) program, for example, went into effect in March, 2016 and mandates universal e-prescribing in an attempt to reduce prescription drug abuse, prevent "doctor shopping" and prevent prescription fraud.
Despite e-prescribing's great promise for reducing painkiller misuse, some providers view universal e-prescribing as an administrative hassle that threatens to disrupt clinical workflows. As e-prescribing adoption becomes more widespread, however, clinicians are recognizing numerous benefits that ultimately enhance patient outcomes.
Increased patient safety
One of the most significant advantages of e-prescribing technology is improvement in patient safety and the quality of care. E-prescribing systems can interface with a patient's medication history and offer clinical alerts to guard against drug-to-drug and drug-to-allergy interactions, inappropriate dosing and duplicate therapies, and, to advise providers of potential problems with patient conditions such as pregnancy or breast-feeding. E-prescribing also reduces common errors inherent in paper-based prescribing, including illegible handwriting, misinterpreted abbreviations and unclear dosages. Combining enhanced medication history with automated clinical decision support also helps to avoid over-prescribing or the prescribing of medications that could adversely interact with a patient's existing medication therapy.
Enhanced security
With e-prescribing, providers can be assured that pharmacists receive prescriptions exactly as written. Unlike with paper prescriptions, which can be subject to tampering and theft, e-prescribed transactions are sent directly to the pharmacies without the risk of any changes to dosages or the number of refills. In addition, the physician's DEA number is not exposed, which reduces the risk of physician identity theft.
Reduced risk of doctor shopping
E-prescribing technology can be linked with a patient's medication history, including some states' prescription drug databases, so that clinicians have a more complete view of the patient's prescription records. With e-prescribing, providers have access to a patient's prescription history at the point-of-care, allowing them to look for any suspicious trends that indicate a patient may be doctor shopping, particularly when controlled substances are involved.
Workflow efficiencies
Despite concerns that e-prescribing can be disruptive to physician workflows, the reality is that e-prescribing can actually increase workflow efficiencies, such as reducing interruptions associated with pharmacy call-backs when orders need to be clarified due to unclear dosage requirements or prescription legibility. A Medical Group Management study found that e-prescribing helps practices achieve an average annual savings of $15,769 per full-time physician as a result of lower administrative burdens related to prescription inquiries from pharmacies and health plans.
Cost savings for patients
E-prescribing provides clinicians with point-of-care exposure to health plan details so that prescribers are made aware of lower-cost medication alternatives, as well as patient co-pay amounts. These details can guide physicians to the most cost-effective and therapeutically appropriate alternatives in order to save patients money and drive medication adherence.
Higher patient satisfaction
E-prescribing enhances patient satisfaction by streamlining the prescription filling process. When prescriptions are forwarded to a pharmacy electronically, a patient spends less time waiting to have their order filled. Usually by the time a patient arrives at their pharmacy, the formulary compliance checks have been completed and medications prepared for pick-up. In addition, the patient spends less money because the provider was able to review the patient's health plan details at the point of care and order the most cost-effective medication. These factors also ensure better medication adherence.
Facilitates prescription analysis
With e-prescribing, organizations can analyze prescription data to better understand what medications are being prescribed in what dosages and for what medical conditions, potentially leading to treatment breakthroughs. Providers can identify variations in prescribing patterns among peers and look for outlier patterns and perhaps avoid unexpected inquiries from law enforcement, other regulators and news media.
As the nation works to solve the country's opioid and prescription drug abuse epidemic, look for more states to mandate the use of e-prescribing for controlled substances. Fortunately, e-prescribing holds great promise for helping to reduce abuse, while at the same time enhancing patient safety, improving security, and streamlining workflows.
Peter N. Kaufman, M.D., is Chief Medical Officer for DrFirst. Dr. Kaufman is a board-certified gastroenterologist, a member of the ONC's Health IT Standards Committee, Privacy and Security Workgroup, and a former co-chair of the Physicians EHR Consortium.
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